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Announcements

10/2020What You Need to Know About Coronavirus
As COVID-19 makes headlines, UPMC Health Plan wants to update you, our network provider, on decisions we have made that will affect you and our members, your patients. UPMC Health Plan is actively monitoring this evolving situation and timely, appropriate care for our members remains our top priority. We are working closely with county, state, and national health agencies and organizations to ensure that we are able to share critical, accurate information that allows both you and our Provider Services team to be prepared for new developments.

Read our provider FAQ.

This information is current as of September 25, 2020. Providers should check back daily for updates.
10/2020Review Appendix A – COVID-19 Special Coverage and Payment Policy
Review our Appendix A - COVID-19 Special Coverage and Payment Policy for the latest policy updates.
10/2020Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower
Learn about the importance of timely HPV immunizations and how to confidently recommend them. Please view Dr. Todd Wolynn’s recorded HPV presentation, Human Papillomavirus Diseases, Vaccination, and Your Healthcare Provider Superpower. Dr. Wolynn is a pediatrician and CEO at Kids Plus Pediatrics in Pittsburgh, Pennsylvania.

This presentation offers an opportunity to review epidemiology and outcomes of HPV infection, including trends in HPV-related cancers. Learn about the importance of HPV vaccination for cancer prevention; possible changes to HPV vaccine recommendations; and recent uptake, safety, and impact data. Earn Continuing Medical Education (CME) credits.*

*In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Physician (CME)
The University of Pittsburgh designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credits.* Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours.
10/2020Recall: Metformin (Marksans Pharma - Oct.)
Marksans Pharma Limited, India, is recalling multiple lots of metformin hydrochloride extended-release tablets, USP, 500 and 750 mg, because of an impurity found in the products above levels established by the FDA. Metformin HCl ER tablets are used to improve blood sugar in adults with type 2 diabetes. Read the full text of the Marksans Pharma metformin recall.
10/2020Notice: ONAF Submission Updates
Beginning November 14, Optum OB Care will be making system updates to their platform. Learn more about the Optum OB Care updates.
10/2020Recall: NP Thyroid (Acella – Sept)
Acella Pharmaceuticals LLC is recalling one lot of 15 mg (Lot # M327E19-1) and one lot of 120 mg (Lot #M328F19-3) NP Thyroid®, Thyroid Tablets, USP [levothyroxine (T4) and liothyronine (T3)] due to it being subpotent (lower than normal or acceptable potency). Read the full text of the NP Thyroid recall.
10/2020UPMC for Life updates for 2021
Get the latest on UPMC for Life plan improvements, changes, and more—including:

Learn more in October's Provider Partner Update.
9/2020Recall: Nature Thyroid and WP Thyroid
RLC Labs, Inc. is recalling 483 lots of Nature-Thyroid® and WP Thyroid® due to it being subpotent (lower than normal or acceptable potency). Nature-Thyroid and WP Thyroid are used for hypothyroidism (underactive thyroid). Read the full text of the Nature Thyroid and WP Thyroid recall.
9/2020Mandatory Training for Medicare SNP Providers
The Centers for Medicare and Medicaid Services (CMS) require all Medicare Special Needs Plan (SNP) providers to complete the Model of Care Training. The Model of Care describes the structure and process by which health care services are delivered to SNP members.

For your convenience, UPMC Health Plan has developed a brief online training module on the Model of Care for our SNP product, UPMC for Life Complete Care (HMO-SNP) (formerly known as UPMC for Life Dual).

To complete the training, go to upmchp.us/snp-moc-2020. You will need your tax identification number to sign up.

If you have any questions or concerns, feel free to contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for your continued support and the care you provide for our members!
9/2020CGMA Announcement
UPMC Health Plan has encountered an unexpected delay processing blood pressure claims for the Partners Program Gaps in Care (CGMA) system. Please be assured we have received all blood pressure claims submitted this year through this system and are prioritizing a resolution to accurately close the gap. All users will receive a notification when the issue has been corrected. At that time, appropriate reporting and status will be accessible within CGMA.

We apologize for the inconvenience and appreciate your patience.
9/2020Update on Member Cost Share for Colorectal Cancer Screenings
UPMC Health Plan is making colorectal cancer (CRC) screening easier and more accessible for our members. We are changing our billing procedures for UPMC Health Plan members who complete a fecal test with a positive result necessitating a follow-up colonoscopy. Learn about the adjustments in our billing guide and provider newsletter.
9/2020New Prior Authorization Forms for Continuous Glucose Monitors available for All Lines of Business
Continuous Glucose Monitors
9/2020Coverage of Telehealth Well-Child Visits
The COVID-19 pandemic has led to unprecedented social distancing measures. These guidelines have encouraged people to avoid leaving their homes except for essentials like groceries or urgent medical care. As such, many parents are postponing pediatric well-visits.

As indicated by the American Academy of Pediatrics (AAP) and Bright Futures periodicity schedule, UPMC Health Plan recommends that children covered by UPMC for Kids, UPMC for You, and Commercial plans see their PCP in person for annual well-visits. However, in light of current social distancing guidelines, UPMC Health Plan will consider well-child visits done via telehealth and conducted in a way that optimizes care delivery as valid well-child visits.

UPMC Health Plan will cover telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and Commercial plans in accordance with AAP and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing.

UPMC Health Plan has developed billing guides to assist providers in administering and billing compliant telehealth well-child visits:

EPSDT Telehealth Billing Guide
Commercial and UPMC for Kids Billing Guide

If you have any questions please contact your physician account executive or call Provider Services at 1-866-918-1595.

Note for all billing guidance for EPSDT: The EP modifier must still be placed first for EPSDT billing consideration.

Remember, these steps are not intended to supersede your preferred methods of care delivery and the provider is responsible for the appropriate billing of services.
9/2020Recall: Metformin ER (Bayshore Pharmaceuticals LLC)
Bayshore Pharmaceuticals LLC is recalling one lot of metformin HCL ER tablets, USP, 500 mg, and one lot of metformin HCL ER tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Bayshore Pharmaceuticals LLC Metformin ER recall.
8/2020LAST CHANCE! Reminder to Encourage Members to Get Preventive Screenings
We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies. We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
8/2020Recall: DDAVP (Ferring–August)
Ferring Pharmaceuticals US is recalling all lots of DDAVP® Nasal Spray 10 mcg/0.1 mL, Desmopressin Acetate Nasal Spray 10 mcg/0.1 mL, and STIMATE® Nasal Spray 1.5 mg/mL because these lots are superpotent (above normal or acceptable potency). These products are used to control fluids and treat some blood disorders. Read the full text of the DDAVP (Ferring - August) recall.
8/2020August 26: Join a Live Presentation on HPV Diseases and Vaccination
Pediatrician Todd Wolynn will discuss HPV and related diseases and recommendations on HPV vaccines from the Advisory Committee on Immunization Practices. Learn about the importance of timely HPV immunizations and earn CME* credits.

Tune in to Dr. Wolynn's presentation on Wednesday, August 26 from noon to 1 p.m. Register today at https://upmchp.us/hpv.

*This activity is approved for the following credit: AMA PRA Category 1 Credit™, and ANCC. Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
8/2020UPMC Health Plan Now Offers a Pain Management Consultation Line for Physicians Across Pennsylvania Treating Our Members
Provider pain management consultation letter

Provider pain management consultation flier
8/2020AnywhereCare Virtual Urgent Care
UPMC AnywhereCare, UPMC Health Plan’s Virtual Urgent Care telemedicine tool, offers a convenient and easy way for patients to get a medical evaluation from home or the office if they are having common conditions like a cold or sore throat, or think they are experiencing COVID-19 symptoms. Patients can have a Virtual Urgent Care visit with a UPMC provider right from their smartphone, tablet, or computer in minutes.* Children up to age 17 can be seen by pediatric providers from UPMC Children’s Hospital of Pittsburgh.** UPMC Health Plan Members pay a $0 visit copay until September 30, 2020. AnywhereCare is available 24/7 and providers can send prescriptions to the patient’s preferred pharmacy, if needed. UPMC AnywhereCare can provide general medical advice, plus treat the following conditions and more:
  • Bronchitis and coughs
  • Cold and flu symptoms
  • Diarrhea
  • Pink eye
  • Rashes
  • Seasonal allergies
  • Sinus infections
  • Tick bites
  • Vaginal yeast infections

Patients can sign up for UPMC AnywhereCare by visiting anywherecare.upmc.com or downloading the UPMC AnywhereCare app from the Apple App Store or Google Play Store.

*UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II P.C. (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. Members located outside of Pennsylvania at the time of service may select the standard UPMC AnywhereCare module and will receive care from a provider employed or contracted by Online Care Network II P.C. (OCN) at the discretion of the provider. OCN is not an affiliate of UPMC.

†Limitations may apply for members of self-funded (ASO) plans that have opted out of coverage.
8/2020Recall: Daptomycin (Mylan—July)
Mylan is recalling one lot (# 7605112) of daptomycin for injection, 500 mg/vial, due to particulate matter being found in one single-dose vial. Read the full text of the Mylan Daptomycin recall.
7/2020Provider Relief Fund Application Process
The U.S. Department of Health and Human Services (HHS), through the Provider Relief Fund (PRF), is distributing $15 billion to eligible Medicaid, CHIP, and dental providers. If you are a provider who is interested in learning about the application process for the PRF, you can visit www.hhs.gov/coronavirus/cares-act-provider-relief-fund for the latest information and updates.
7/2020Recall: Metformin ER (Lupin2) (Lupin Pharmaceuticals Inc.)
Lupin Pharmaceuticals Inc. is recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 1000 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Lupin Pharmaceuticals Inc. recall.
7/2020Recall: Metformin ER (Granules Pharmaceuticals Inc.)
Granules Pharmaceuticals Inc. is recalling 12 lots of Metformin HCL ER Tablets, USP, 750 mg, because of an impurity found in the products above levels established by the FDA. Read the full text of the Granules Pharmaceuticals Metformin ER recall.
7/2020UPMC Announces Patient-centered Initiative to Reduce Out-of-Pocket Prescription Drug Costs for UPMC Health Plan Members
Read the full press release.
7/2020EPSDT Periodicity Schedule Update
The EPSDT Periodicity Schedule has been updated to reflect the changes made by DHS Bulletin 99-20-04 on May 26, 2020.
7/2020Reminder to Encourage Members to Get Preventive Screenings
We would like to remind you of our preventive screening incentive program for your patients enrolled in a UPMC for Life plan. Members who meet the eligible HEDIS criteria and complete certain preventive services between January 1, 2020, and December 31, 2020, can receive a UPMC for Life Visa® Prepaid Card.* This card can be used everywhere that Visa debit cards are accepted. View a flier that explains the program and who qualifies.

We hope you will encourage eligible UPMC for Life members to participate!

*Card is issued by MetaBank®, member FDIC, pursuant to a license from Visa USA Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to six months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
6/2020Update Your Profile With Demographic Information About Providers in Your Office
You can now give racial, ethnic, and linguistic information about providers in your office on the Provider Change Form (under the Update Race/Ethnicity and Language Information section). While providing this information is voluntary, it can help accommodate increasingly diverse patient populations who may face disparities in health care because of language and other related barriers. For example, giving patients the option to connect with providers who speak their first language can help them feel comfortable and make more informed decisions about their care.* Language and language service information will still be available through UPMC Health Plan’s provider directory. However, demographic information will only be made available to individual members upon request.

*Mullins CD, Blatt L. Health disparities: A barrier to high-quality care. Am J Health Syst Pharm. 2005 September 15; 62(18):1873–18.doi: 10.2146/ajhp050064
6/2020Dr. Schuster's and Dr. Hurford's Viewpoint: Addressing the Mental Health Impact of COVID-19
Dr. Schuster and Dr. Hurford recently co-authored an article on mental health and how it has been affected during the COVID-19 pandemic. Read the full article on Dr. Schuster's and Dr Hurford's discussion.
6/2020Telehealth Well-Child Visits
UPMC Health Plan covers telehealth well-child visits for pediatric members of UPMC for Kids, UPMC for You, and commercial plans in accordance with American Academy of Pediatrics and Bright Futures recommendations. Coverage varies based on the need for in-person well-child testing. Further coverage guidance will be provided in the coming weeks to help providers make determinations regarding appropriate types of visits.
6/2020Recall: Metformin ER (Marksans Pharma)
Marksans Pharma Limited, India, is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the Marksans Pharma Metformin ER recall.
6/2020Recall: Metformin ER (Teva)
Teva Pharmaceuticals USA Inc. is recalling 14 lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Teva Pharmaceuticals Metformin ER recall.
6/2020Equitable access to patient-centered, high-quality health coverage and health care
We are aware that on June 12, 2020, HHS announced modifications to the 2016 rule implementing Section 1557 of the Affordable Care Act that, among other things, remove protections against discrimination in health coverage based on sex stereotyping and gender identity. We at the UPMC Insurance Services Division believe that every individual deserves to have equitable access to patient-centered, high-quality health coverage and health care that is provided with dignity and respect. Our commitment to nondiscrimination will not change based on the weakening of Section 1557 or the narrowing of sex- and gender-related regulatory protections. We will continue in our ongoing efforts to establish, maintain, and reinforce dignity, respect, and equality for all of our members. Toward this end, we will continue to apply coverage terms and member cost sharing equally and without regard for gender identity or gender expression. The rule will not change our existing coverage policies for gender-affirming procedures and related health services for our insurance members. In short, the UPMC Insurance Services Division will continue to do everything it can to ensure that all members continue to have access to the care and coverage they need.
6/2020UPMC Health Plan Extends Members' No-cost Access to Telehealth Services
Until September 30, 2020, UPMC Health Plan will waive all member cost sharing—including deductibles and copayments— for covered services provided via telehealth with in-network providers.* This also applies to telehealth services from UPMC AnywhereCare, FQHCs, and RHCs. UPMC Health Plan requests that POS 02, modifier 95, or both be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.

This extension until September 30, 2020, applies to individuals enrolled in UPMC Health Plan’s fully-insured commercial group coverage, individual ACA Marketplace plans, UPMC for Kids, and our UPMC for Life Medicare Advantage plans.

UPMC Health Plan’s technical requirements and information on covered telehealth services can be found in UPMC Health Plan policy MP.148, which is available online through our Policies and Procedures Manual. Temporary changes to our telehealth coverage policy can be found in Appendix A – COVID-19 Special Coverage and Payment Policy.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services. Coverage of some services may be limited following the end of the national COVID-19 emergency period.
6/2020Recall: Metformin ER (Apotex)
Apotex Corp. is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Apotex) recall.
6/2020Appendix A – COVID-19 Special Coverage and Payment Policy Updates
UPMC Health Plan had temporarily extended the timely filing requirement for administrative and medical necessity provider appeals. The timely filing requirement was extended from within 30 business days of the initial denial notification to within 60 business days of the initial denial for the dates of 3/15/20 – 6/15/20. This appeals extension will end on 6/15/20. For coverage decisions made on or after 6/15/20, standard filing timelines will apply.
6/2020Recall: Metformin ER (Amneal)
Amneal Pharmaceuticals LLC is recalling all lots of metformin hydrochloride extended-release tablets, USP, 500 mg and 750 mg, because of an impurity found in the products above the acceptable levels established by the FDA. Read the full text of the Metformin ER (Amneal) recall.
6/2020Recall: NP Thyroid
Acella Pharmaceuticals LLC is recalling several lots of NP Thyroid, which have been deemed superpotent. Read the full text of the recall.
6/2020CGMA Announcement
There is a new feature in the CGMA that will allow record transfer uploads to support the removal of members from the member roster. The documents can be uploaded under the current “Verify Patient Affiliation” option by selecting “Patient is seeing a Primary Care Physician at a different office,” then choosing “YES” under "Medical Record Transfer Documentation." The documentation must include Authorization for Release of Protected Health Information, including the signature of the patient or parent/legal guardian, if the patient is younger than age 18. The name of the provider to whom the Protected Health Information is released should also be documented. Please see the FAQ within the CGMA on the provider portal documents and forms "Provider Training" section for additional information.
6/2020UPMC Health Plan Extends Members’ No-cost Access to Telehealth Services
Read the full details in our latest press release. UPMC Health Plan requests that POS 02 or modifier 95 (with any other appropriate POS) be included with all telehealth visits for any UPMC Health Plan member claim to ensure appropriate processing of $0 member cost sharing.
6/2020Medical Policy Pulled: MP.159
MP.159 was recently pulled for further consideration by multiple stakeholders that may necessitate policy refinement. More information will be posted as it becomes available.
5/2020Recommendations for Completing Medicare Annual Wellness Visits Via Telehealth
UPMC Health Plan is prioritizing the health of our Medicare members through the Medicare annual wellness visit (AWV). The AWV is integral to our members’ health because it can be used as an opportunity for gap closure. Conveniently for Medicare members, AWVs can be conducted through telehealth.

We have developed a complimentary AWV booklet and webinar to assist providers in administering and billing compliant AWVs:

Remember, these steps are not intended to supersede your preferred methods and the provider is responsible for the appropriate billing of services. You are not required to use our resource material, but it is intended to support accurate Medicare AWV documentation.

Additionally, we recognize that some Medicare and SNP members may not have video capability. In these cases, AWVs can be conducted via audio. Per CMS guidelines, an HCC screening can only be captured using synchronous audio and video. As a best practice, UPMC Health Plan is recommending that telehealth AWVs be conducted via real-time synchronous audio and video. If the AWV is audio-only, be sure to schedule an in-person AWV to capture HCCs and other screenings such as BMI, blood pressure, and HbA1C.
5/2020IMPORTANT: ALL NETWORK PROVIDERS
UPMC Health Plan is enhancing its existing claims editing procedure to improve claims processing accuracy. The effective date was previously communicated as April 1, 2020, but due to COVID-19 the go-live date was changed to June 15, 2020. Beginning June 15, 2020, UPMC Health Plan will closely review claims that have been billed with certain modifiers. These modifiers are sometimes used incorrectly to override unbundling edits. Specifically, modifier 25 should only be used to indicate separately identifiable E/M services, and modifiers 59, XE, XS, XP, and XU should only be used to indicate that a procedure or service is distinct or independent from other services performed on the same day. To align with industry standard coding guidelines and modifier descriptions, UPMC Health Plan’s review will use nationally sourced guidelines to determine the appropriateness of a modifier used to bypass code edits. This enhanced editing process will provide claim adjudication that more closely aligns with coding guidelines.
5/2020Update: SEP for those affected by COVID-19
On Tuesday, May 5, 2020, CMS released a memo announcing that there is a Special Enrollment Period (SEP) available nationwide to individuals who have been affected by COVID-19. To qualify for this special enrollment period the below criteria must be met.

An SEP exists for individuals affected by a major disaster who were unable to and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.

Individuals will be considered “affected” and eligible for this SEP if they:

  • Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
  • Had another valid election period at the time of the incident period; and
  • Did not make an election during that other valid election period.

In addition, the SEP is available to those individuals who do not live in the affected areas but rely on help making health care decisions from friends or family members who live in the affected areas.

The SEP is available from the start of the incident (March 1) and for four full calendar months after the start of the incident period (June 30).

Individuals will be given one opportunity to make that missed election and will not be expected to provide proof that they were affected by the pandemic-related emergency.

Read the full announcement from CMS.
5/2020Encourage your UPMC for Life patients to complete their annual wellness visit from home
Through telehealth video visits, your patients can complete an annual wellness visit and talk with a doctor or provider face-to-face to get medical care and advice.

Until June 15, all UPMC for Life members have a $0 copay for telehealth services. Plus, if they complete an annual wellness visit by December 31, they will receive a $20 UPMC for Life Visa® Prepaid Card to use anywhere Visa debit cards are accepted.

Once your patients complete their annual wellness visit through telehealth and you submit a claim, it may take up to 32 days for them to receive their reward in the mail. You can help your patients get their reward sooner by submitting your claims promptly!

If you have any questions about telehealth or the preventive care rewards program, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Card is issued by MetaBank®, N.A., Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 6 months, funds do not expire and may be available after card expiration date, fees may apply. Card terms and conditions apply.
5/2020Recall: Ketorolac Tromethamine Injection
Fresenius Kabi USA LLC is recalling numerous lot numbers of Ketorolac Tromethamine Injection due to the presence of particulate matter found in sample vials. Read the full text of the recall.
5/2020Recall: Tetracycline Capsules
Avet Pharmaceuticals Inc. is recalling numerous lot numbers of Tetracycline HCl Capsules, 250 and 500 mg, because of low amounts of tetracycline. Read the full text of the recall.
5/2020Recall: Nizatidine Oral Solution
Amneal Pharmaceuticals LLC is recalling three lots of Nizatidine Oral Solution, 15 mg/mL (75 mg/5 mL), because of an impurity found in the products above acceptable levels established by the FDA. Read the full text of the recall.
4/2020Most Recent FQHC/RHC Telehealth Guidance
We know you have many questions regarding telehealth services available to UPMC Health Plan members during the COVID-19 public health emergency (PHE). Federally Qualified Health Centers, Look-A-Like, and Rural Health Clinics can read more about our telehealth guidance.
4/2020Announcing UPMC Children's AnywhereCare
UPMC Health Plan’s telemedicine service—UPMC AnywhereCare—has expanded to offer care to children of all ages.

With UPMC Children’s AnywhereCare, children up to age 17 can have Virtual Urgent Care visits 24/7 with UPMC Children’s Hospital of Pittsburgh providers over live video. All your patients need is a smartphone, tablet, or computer.

UPMC Health Plan will waive all cost-sharing—including copays and deductibles—until June 15, 2020, for UPMC Health Plan members who use this service.*

UPMC Children’s AnywhereCare allows children to get medical attention quickly and safely from their home. Providers can screen children who may have been exposed to COVID-19, and they can provide treatment for these and other conditions commonly treated by a pediatrician or urgent care provider:
  • Bronchitis and coughs
  • Cold and flu symptoms
  • Diarrhea
  • Pink eye
  • Rashes
  • Sinus infections
  • Tick bites
  • Urinary tract infections

UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania.** Patients who are 3 or older can also use the standard UPMC AnywhereCare service if they need medical assistance.

We hope you will tell your patients or their parents about this convenient care option. Remember, UPMC Health Plan members can have no-cost visits through June 15. Patients who are not UPMC Health Plan members can still use UPMC Children’s AnywhereCare when they are in Pennsylvania; however, they will be charged $59 for their visits.

Patients or their parents can sign up for UPMC Children’s AnywhereCare by visiting anywherecare.upmc.com or downloading the app from the Apple App Store or Google Play.

*While almost all of our individual and group plans include extensive telehealth benefits, some ASO/self-funded employer plans do not cover telehealth services.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (“OCN”) at the discretion of the provider. OCN is not an affiliate of UPMC.
4/2020Market withdrawal: Ranitidine (Zantac) products
The U.S. Food and Drug Administration (FDA) has requested that all manufacturers of ranitidine products withdraw the drug from the U.S. market because of an impurity found in the products above levels established by the FDA. The impurity is a chemical called N-Nitroso dimethylamine (NDMA) and it is a probable human carcinogen. Read the full text of the withdrawal.
4/2020Staying in Touch
UPMC Health Plan’s Staying in Touch events can help your patients stay connected and informed during this challenging time. Your patients can join us to hear about staying healthy, managing stress, being active, and connecting with their community—all from the comfort of home!

      •Hosted by experts on preventive medicine, mental health, and other topics.
      •Participants can stay for all or part of these 30- to 45-minute events.
      •Participants can join by phone or online.

For more information or to join an event, visit our Staying in Touch Events page.
3/2020Managing Withdrawal From Alcohol Addiction During the COVID-19 Crisis
Read our provider notice on managing withdrawal from alcohol addiction during the COVID-19 crisis.
3/2020What You Need to Know About Coronavirus
As COVID-19 makes headlines, UPMC Health Plan wants to update you, our network provider, on decisions we have made that will affect you and our members, your patients. UPMC Health Plan is actively monitoring this evolving situation and timely, appropriate care for our members remains our top priority. We are working closely with county, state, and national health agencies and organizations to ensure that we are able to share critical, accurate information that allows both you and our Provider Services team to be prepared for new developments.

Read about billing updates.

Read about telehealth services.

Read our Community Care Behavioral Health Telehealth Services update.
3/2020Phenytoin Oral Suspension USP, 125 mg/5 mL
Taro Pharmaceuticals U.S.A. Inc. is recalling these two lot numbers of Phenytoin Oral Suspension USP,125 mg/5 mL, NDC# 51672-4069-1: #327874 and #327876 (expiration date December 2020). This recall is for safety reasons. Phenytoin Oral Suspension is used to treat seizures. Read the full text of the withdrawal.
3/2020Market Withdrawal: Belviq and Belviq XR (Lorcaserin)
The U.S. Food and Drug Administration (FDA) has asked Eisai Inc.—which manufactures the weight loss drugs Belviq and Belviq XR (lorcaserin)—to withdraw the drugs from the U.S. market because of a safety clinical trial that showed an increased occurrence of cancer. Read the full text of the withdrawal.

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2019 Announcements

9/2019Recall: Relpax 40 mg Tablets
Relpax is manufactured by Pfizer Inc. Two lot numbers of this medication have been recalled for safety reasons. This recall is due to the possible presence of bacteria. To date, Pfizer Inc. has not received any customer complaints or reports of adverse events related to this issue. Read the full text of the recall.
8/2019Recall: Drospirenone and Ethinyl Estradiol Tablets, USP
Jubilant Cadista Pharmaceuticals Inc. is recalling one lot of Drospirenone and Ethinyl Estradiol Tablets, USP, 3 mg/ 0.02mg due to concern that the medication will not work as well as it should. This is based on lab test results on how the medication is absorbed into the body. To date, Jubilant Cadista Pharmaceuticals Inc. has not received any reports of adverse events. Read the full text of the recall.
7/2019UPMC Health Plan would like to announce the new Hip and Knee Joint Replacement Centers of Excellence
UPMC Health Plan has established a Center of Excellence program for elective hip and knee joint replacement surgery to promote high-quality outcomes for members. The UPMC Health Plan Hip and Knee Joint Replacement Surgery Center of Excellence program recognizes surgical facilities and orthopedic surgeons that demonstrate high-quality outcomes, low complication rates, and the best patient experience for UPMC Health Plan members in need of joint replacement surgery. More information is available at upmchp.us/hip-knee-coe.
6/2019Recall: Losartan Potassium Tablets, USP
The FDA advises that patients who are on Losartan Potassium Tablets and Losartan Potassium/Hydrochlorothiazide combination tablets, USP should continue taking their medication and contact their pharmacist, physician, or medical provider for advice regarding an alternative treatment, as the risk of harm to the patient’s health may be higher if the treatment is stopped immediately without any alternative treatment. Read the full text of the recall.
6/2019Recall: Fentanyl
Heritage Pharmaceuticals Inc. is recalling lot #VEAC025 of Amikacin Sulfate Injection, USP, 1g/4 mL (250mg/mL) and lot #VPCA172 of Prochlorperazine Edisylate Injection, USP, 10mg/2mL (5mg/mL). This recall was issued because microbial growth was detected in unreleased medication. Read the full text of the recall.
6/2019Recall: Fentanyl
Alvogen Inc. is recalling two lots of Fentanyl Transdermal System 12 mcg/h transdermal patches because of mislabeling. A small number of cartons labeled 12 mcg/h Fentanyl Transdermal System patches contained 50 mcg/h patches. Read the full text of the recall.
5/2019EPSDT changes now in effect
Please note that changes have been made to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Periodicity Schedule. These changes were made in response to the Department of Human Services (DHS) Medical Assistance Bulletins released on August 1, 2018, and are relevant to all Medical Assistance providers. View the updated EPSDT Periodicity Schedule and UPMC for You billing guide.
5/2019Recall: Losartan Potassium Tablets, USP
Based on the available information, the risk of developing cancer following long-term use of the product containing high levels of the impurity NMBA cannot be ruled out. The FDA advises that Consumers should contact their doctor for further guidance and potential change of treatment before they stop taking the product. Read the full text of the recall.
4/2019Recall: Valsartan and Amlodipine/Valsartan
Aurobindo Pharma USA Inc. is recalling 39 lots of Valsartan and Amlodipine/Valsartan tablets because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
4/2019Recall: Losartan Potassium Tablets, USP
Legacy Pharmaceutical Packaging, LLC is recalling 3 repackaged lots of Losartan Potassium Tablets, USP, 50 mg. This recall was prompted due to Torrent Pharmaceuticals LTD issuing a voluntary nationwide recall of Losartan Tablets, USP, because of an impurity found in the product. Read the full text of the recall.
4/2019Recall: Losartan Potassium Tablets, USP
Legacy Pharmaceutical Packaging, LLC is recalling 40 repackaged lots of Losartan Potassium Tablets, USP, 25 mg, 50 mg, and 100 mg. This recall was prompted due to Camber Pharmaceuticals, Inc. issuing a voluntary nationwide recall of Losartan Tablets, USP, because of an impurity found in the product. Read the full text of the recall.
3/2019Recall: Losartan/Hydrochlorothiazide (Macleods)
Macleods Pharmaceuticals Limited is recalling one lot number of Losartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
3/2019Recall: Irbesartan and Irbesartan/Hydrochlorothiazide
Prinston Pharmaceutical Inc., dba Solco Healthcare LLC, is recalling 1 lot of Irbesartan and 7 lots of Irbesartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
3/2019Recall: Losartan and Losartan/HCTZ (Torrent)
Torrent Pharmaceuticals Limited is recalling 10 lot numbers of Losartan and 6 lot numbers of Losartan/Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
1/2019Recall: Valsartan
Aurobindo Pharma USA Inc. is recalling 80 lots of Valsartan, Amlodipine and Valsartan, and Valsartan and Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
1/2019Recall: Losartan (Torrent)
Torrent Pharmaceuticals Limited is recalling 10 lot numbers of Losartan because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.

2018 Announcements

12/2018Recall: Infant Ibuprofen
Tris Pharma Inc. is recalling three lots of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL. The recalled lots have been found to potentially contain higher concentrations of ibuprofen. No problems linked to this recall have been reported. Read the full text of the recall.
12/2018Recall: Sodium Chloride Injection .09%
Fresenius Kabi USA is recalling 163 lots of Sodium Chloride Injection 0.9% vials because of mislabeling. The product insert states that stoppers for both the 10 ml and 20 ml vials do not contain rubber latex. However, the product is being recalled because the stoppers have been found to contain natural rubber latex. Read the full text of the recall.
12/2018Recall: Losartan HCTZ
Mylan Pharmaceuticals is recalling select lot numbers of Valsartan, Amlodipine and Valsartan, and Valsartan and Hydrochlorothiazide because of an impurity found in the product. The impurity—N-nitrosodiethylamine (NDEA)—is classified as a probable human carcinogen. Read the full text of the recall.
11/2018Recall: Losartan HCTZ
Sandoz Inc. is recalling lot number JB8912 of Losartan Hydrochlorothiazide because of an impurity found in the drug product. No problems linked to this recall have been reported so far. Read the full text of the recall.
11/2018Recall: Ortho-Novum
Janssen Pharmaceuticals Inc. is recalling several lots of Ortho-Novum 7/7/7 and 1/35 tablets because the patient information provided inside affected packages does not include the appropriate instructions for the dispenser. The Ortho-Novum product itself remains safe and effective for use with the appropriate dispenser instructions. Read the full text of the recall.
11/2018Recall: Ibesartan
ScieGen Pharmaceuticals is voluntarily recalling all unexpired lots of Irbesartan because of an impurity found in the product. Companies affected by this recall include Golden State Medical Supply Inc. (GSMS) and Westminster Pharmaceuticals. Read the full text of the recall.
8/2018Recall: Valsartan and Valsartan/Hydrochlorothiazide (HCTZ)
Solco Healthcare, Teva Pharmaceuticals Industry Ltd., Major Pharmaceuticals, Camber Pharmaceuticals, Northwind Pharmaceuticals, and several repackaging manufacturers are voluntarily recalling all unexpired lots of Valsartan and Valsartan/Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
8/2018Recall: Levothyroxine or Liothyronine (Thyroid Tablets)
Westminster Pharmaceuticals, LLC is voluntarily recalling all unexpired lot numbers of Levothyroxine and Liothyronine (Thyroid Tablets, USP) 15 mg, 30 mg, 60 mg, 90 mg, and 120 mg. These products are being recalled as a precaution because they were manufactured using active pharmaceutical ingredients sourced prior to a 2017 inspection that found one supplier to have deficiencies with Current Good Manufacturing Practices (cGMP). Read the full text of the recall.
8/2018Recall: Valsartan and Valsartan/Hydrochlorothiazide
Solco Healthcare, Teva Pharmaceuticals Industry Ltd., and Major Pharmaceuticals are voluntarily recalling all unexpired lots of Valsartan and Valsartan/Hydrochlorothiazide because of an impurity found in the product. Read the full text of the recall.
6/2018Provider Manual Update
The UPMC for You (Medical Assistance) chapter of the UPMC Health Plan Provider Manual has been updated with an effective date of July 1, 2018. To view the most recent changes, visit our Provider Manual page.
6/2018Recall: Fluticasone Propionate Nasal Spray
Apotex Corp. is voluntarily recalling one lot of Fluticasone Propionate Nasal Spray due to containing small glass particles. Read the full text of the recall.
6/2018Recall: Naloxone Hydrochloride Injection
Hospira Inc. is voluntarily recalling two lots of Naloxone Hydrochloride Injection because of the potential presence of embedded and loose particulate matter on the syringe plunger. Read the full text of the recall.
5/2018Recall: Ampicillin and Sulbactam for Injection
AuroMedics Pharma LLC is voluntarily recalling two lots of Ampicillin and Sulbactam for Injection because customers noticed red particulate matter in the product. Read the full text of the recall.
3/2018Recall: Methylprednisolone Sodium Succinate for Injection
Sagent Pharmaceuticals Ltd. has initiated this voluntary recall of Methylprednisolone Sodium Succinate for Injection, USP to the user level due to the discovery of high out-of-specification impurity results. Read the full text of the recall.
3/2018 Alcohol Use and Alcohol Problems Event
We want to help you, help your patients. UPMC Health Plan is hosting an event to discuss and share resources that help your patients and their families cope with an alcohol problem. Learn more about the event.
2/2018 Reminder: Update PROMISe IDs
Effective January 1, 2018, UPMC for You Medicaid, UPMC for Kids CHIP, and UPMC for Life Dual Medicare SNP providers must have updated PROMISe ID numbers to render, order/refer, or prescribe items or services to patients covered under those plans. If you do not have a PROMISe ID, claims will be denied.
Don’t wait — enroll online now!
2/2018 Align yourself with thought leaders
Our leaders are applying their expertise, along with creativity and rigor, to some of the most challenging problems in health care delivery and financing. Our latest research findings can give you a unique perspective and new ideas on current topics.
To review the latest thought leadership lineup, please visit http://upmchp.us/research.
1/2018 Obstetrical Needs Assessment (OBNA) form submission
Please submit the obstetrical needs assessment form (OBNA) electronically via Optum OB Care or EPIC. Provider offices without capability for EPIC submission should use Optum OB Care. Faxed copies will not be accepted.
1/2018 Recall: Clopidogrel 75 mg tablets
International Laboratories, LLC is voluntarily recalling Lot# 117099A of Clopidogrel tablets, USP 75 mg, packaged in bottles of 30 tablets, to the consumer level due to mislabeling. The product is labeled as Clopidogrel tablets USP 75 mg but may contain Clopidogrel 75 mg or Simvastatin 10 mg. Read the full text of the recall.
1/2018 Obstetrical Needs Assessment (OBNA) form submission
Please submit the obstetrical needs assessment form (OBNA) electronically via Optum OB Care or EPIC. Provider offices without capability for EPIC submission should use Optum OB Care. Faxed copies will not be accepted.

2017 Announcements

9/2017 Recall: All liquid products manufactured by PharmaTechLLC
As a precautionary measure, the distribution firms Leader Brand, Major Pharmaceuticals, and Rugby Laboratories are jointly issuing a nationwide voluntary recall of all lots within expiry of all liquid products manufactured by PharmaTechLLC at its FDA registered facility in Davie, FL, due to possible product contamination. Read the full text of the recall.
9/2017 Recall: Vancomycin Hydrochloride for Injection, USP, 750 mg/vial
Vancomycin Hydrochloride for Injection is manufactured by Hospira. The company recalled one lot number of the medication for safety reasons. This recall is because of the presence of particulate matter. Read the full text of the recall.
9/2017 Recall: Lorazepam Oral Concentrate, USP 2 mg/ml
Lorazepam Oral Concentrate, USP 2mg/ml is being recalled for safety reasons. The dropper may have dose markings in reverse number order, no dose markings, or dose markings that are shifted. Read the full text of the recall.
9/2017 Recall: Pravastatin 40 mg tablet
Pravastatin 40 mg tablets are being recalled for safety reasons. The product may also be labeled as Pravastatin SodiumTablets USP 40 mg but contains Bupropion Hydrochloride XL 300 mg tablets. Read the full text of the recall.
8/2017 Prescription Drug Misuse and Addiction Resources
Like you, we’re here for our community. UPMC Health Plan is hosting an event to discuss and share resources that help your patients and their families cope with a prescription drug problem. Stay educated about the prescription drug epidemic. Learn more about the event.
6/2017 Recall: Eliquis (apixaban) 5 mg tablet
Eliquis (apixaban) 5 mg tablets are being recalled as a precautionary measure from a customer complaint that a bottle labeled as Eliquis 5 mg was found to contain Eliquis 2.5 mg tablets. Read the full text of the recall.
6/2017 Recall: Mibelas 24 Fe Chewable Tablets
Mibelas 24 Fe Chewable Tablets are being recalled for safety reasons because these tablets may be out of sequence and missing expiry/lot information. Read the full text of the recall.
4/2017 Recall: EpiPen and EpiPen Jr Auto-Injectors (epinephrine injection)
EpiPen® and EpiPen® Jr Auto-Injectors are being recalled for safety reasons because these devices may contain a defective part that may result in the devices’ failure to activate. Read the full text of the recall with a list of lot numbers.

2014 Announcements

7/2014 Not all preventive screenings are EHBs
Under the Affordable Care Act, certain preventive services, known as Essential Health Benefits (EHB), are covered at 100 percent. However, not all preventive screenings are EHBs. A screening may be preventive and medically necessary, but if it is not on the list of EHBs, your patient may have a cost share. For a complete list of all preventive services covered at 100 percent, visit www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1/. If there are any questions, you can call Provider Services at 1-866-918-1595 for clarification. Or members can call a Health Care Concierge at the number listed on the back of their card.